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Genital and subjective sexual arousal in women : effects of menopause, sympathetic nervous system activation, and arousal disorder Brotto, Lori Anne

Abstract

Despite three decades of psychophysiological research on female sexual arousal, inconsistencies in the literature with respect to the influence of age, menopause, sympathetic nervous system (SNS) activation, and sexual dysfunction leave clinicians and researchers with an incomplete picture of the female sexual response. The present investigation was aimed at increasing our understanding of female sexual arousal by exploring (1) the effects of age and menopause; (2) the effects of SNS activation on premenopausal, postmenopausal, and women with female sexual arousal disorder (FSAD); (3) the diagnostic utility of the vaginal photoplethysmograph (VPP); and (4) the relationship between laboratory-based and at-home sexual arousal. Experiment 1 found no significant differences in genital or subjective sexual arousal between 25 premenopausal, 25 postmenopausal, and 21 perimenopausal women agematched to the postmenopausal group. SNS activation significantly increased genital sexual arousal in young women, but had no effect on subjective measures. In Experiments 2 and 3, genital and subjective sexual arousal were compared in 30 control and 31 women with FSAD. Three subtypes of FSAD emerged: "genital arousal disorder" characterized women with impaired genital arousal, "anhedonic arousal disorder" characterized women with impaired subjective sexual arousal, and "missed arousal disorder" characterized women who complained of both types of impairment, but who displayed normal VPP patterns. SNS activation significantly impaired genital arousal in women with anhedonic arousal disorder, near significantly increased it in women with genital arousal disorder, and had no effect in women with missed arousal disorder. No subjective measure was significantly affected. Experiment 4 examined the relationship between laboratory-based and at-home sexual arousal in control and FSAD groups. Using a detailed interview to assess at-home sexual arousal, these indices were found not to correlate with genital arousal assessed in the laboratory. Taken together, these results suggest that the genital arousal response is robust to the effects of age and menopause, but is significantly affected by SNS activation depending on diagnostic status. There is support for putative subtypes of FSAD, and future clinical trials should investigate the efficacy of SNS activating techniques across such subtypes. Finally, female sexual arousal is a complex response involving unique contributions of subjective and genital arousal. Optimal assessment of sexual arousal in women would benefit from combining psychophysiological and self-report assessment techniques.

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